The National Cholesterol Education Program (NCEP) identified diet therapy as the first line of treatment for hypercholesterolemia. NCEP guidelines suggest that a physician and other health professionals implement the Step 1 diet and that a registered dietitian (RD) implement Step 2 diet therapy. In order to evaluate the effectiveness of this approach, the investigators randomly assigned 90 patients (60 males, 30 females) aged 21-65 with hypercholesterolemia and not on hypolipidemic drugs to receive either medical nutrition therapy (MNT) from RDs or usual care (UC) from physicians or nurse practitioners. Dietitians provided MNT using a NCEP based cholesterol lowering protocol which required 2-6 visits over 6 months depending on lipid results. During the 6 month intervention period, physicians and patients agreed not to use cholesterol lowering drugs. Changes from baseline were compared between treatment groups using analysis of covariance controlling for baseline and gender.